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Best Treatment for Tendinopathy

It’s not clear what is the best treatment for tendinopathy. That’s the conclusion of researchers reviewing all the published studies on the topic. Tendinopathy refers to a painful tendon condition caused by overuse. Although it feels like it, it’s not the same as tendonitis. There’s pain but no actual inflammation.

Treatment has traditionally focused on providing anti-inflammatory measures. This has included nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, and physical therapy modalities. Stretching and strengthening exercises have always been a part of the standard treatment approach.

More recently, shock wave therapy, low-level laser therapy, sclerotherapy, and growth factors and stem cell treatment have been added. The results of all treatment methods were compared by performing a literature review. The authors summarized the results of 177 studies. They did not evaluate the quality of the work done.

For the most part, it appears that NSAIDs and cortisone injections offer short-term relief. There just isn’t a long-term benefit of these treatments. Results using heat and light modalities seem inconsistent. But this may be more likely to occur because of how the studies were conducted. Without consistent methods and measures, it’s difficult to compare one study to another.

The most effective treatment may be eccentric lengthening exercises, sclerotherapy, and nitric oxide patches. Eccentric exercises are done by placing the affected muscle in a shortened position then lengthening the muscle against resistance.

Sclerotherapy is the injection of a chemical to produce scarring in the blood vessels. The idea is to close down tiny blood vessels and destroy nerve fibers that form in the damaged area. Nitric oxide has some potential for tendon healing. A patch placed over the skin delivers an enzyme that acts as a chemical messenger to provide pain relief.

Newer treatments such as growth factors and stem cells look promising. But these approaches haven’t been studied enough to know what’s most effective. For now, it looks like a short course of NSAIDs and physical therapy with eccentric contraction exercises is a good way to get started. If eccentric exercises don’t help, then alternate treatment can be explored.

Large multi-center studies with control subjects comparing each treatment type are needed. Using controls means results for patients treated are compared with control groups who do not receive treatment. Many of today’s current studies did not include controls.

Brett M. Andres MD, and George A. C. Murrell, MD, Dphil. Treatment of Tendinopathy. In Clinical Orthopaedics and Related Research. July 2008. Vol. 466. No. 7. Pp. 1539-1554.

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